Pearl City High School Alumni Association Membership Form

Mr. Ms. Mrs. Dr .

First Name

Last Name
Middle Initial
Maiden Name (if applicable)


Year Graduated (if alumni) 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 None

Home Address:


Home Phone


Employer

Job Title


Business Address


Work Phone

Fax Phone

E-mail Address

Web Site (URL)


Dues:
New member ($10 initiation fee, plus $10 annual dues = $20.00 Renewing member (annual dues only) $10

Additional Gift:
$

Please make checks payable to Pearl City High School Alumni Association and mail to PCHS Alumni Association at 2100 Hookiekie Street, Pearl City, Hawaii 96782.